辛亥革命博物馆（新馆）建筑设计及首义南轴线城市设计方案国际征集InternationalDesignCompetitionforXinhaiRevolutionMuseumandSouthAxisAreaofWuchangUprising资格预审申请书Pre-QualificationApplication规划设计项目名称：ProjectNameofPlanning：申请机构(盖章)：CompanyorJointVentureNameofApplication(Stamp)：法定代表人或其委托代理人(签字或盖章)：LegalRepresentativeorAttorney（SignatureorStamp）：地址（Address）：日期（Date）：年月日报名表ApplicationFormA基本情况BasicInformationaboutDesigner1公司注册名称RegisteredNameofCompanyorJointVenture2公司详细资料DetailedInformation法定代理人LegalRepresentative常驻地址PermanentAddress电话MainTelephone传真Fax电子邮箱和网址EmailandWebsite公司成立日期DateEstablished设计资格的种类/级别QualifiedCategory/ClassofDesignPractice3本项目联系人PeopletoContactinthisProject姓名Name(Mr./Ms.)头衔和职务TitleandPosition通信地址MailingAddress4商业登记/营业执照BusinessOperatingLicense登记日期和编号DateLicenseIssuedandRegisteredNumber登记地PlaceofRegistration在中国的分支机构登记注册情况（若无，可不填）B公司在相关类似项目中的设计经验WorkingExperiencesandProjectHistorywithSimilarScaleandNatureProject1简述项目名称和地点/所承担的设计内容BriefDescriptionofProjectandDesignAssignment合同完成情况和获奖情况ContractPerformanceandAwardsReceived客户/业主情况ClientInformation参加人员及其分工BriefSummaryoftheTaskforceDedicatedtothisProjectProject2Project3C本项目中拟出任的主要设计人员一WorkingExperiencesandProjectHistorywithSimilarScaleandNature姓名Name学历、学位及专业特长ProfessionalPreparation详细任职历史（自现职开始）Appointments(inreversechronologicalorder)获得的国内或国际奖项Awards,Prizes,andHonorsReceived设计经验（主要填写相似工程）SynergisticActivities(alistoftotheeexamplesthatdemonstrateyourprofessionalcompetenceinsimilarproject)项目名称NameofProject1项目规模、特点及性质ProjectDescription项目名称NameofProject2项目规模、特点及性质ProjectDescription项目名称NameofProject3项目规模、特点及性质ProjectDescription拟在本项目中担任的职务及责任ProposedAppointmentinthisProjectC本项目中拟出任的主要设计人员二WorkingExperiencesandProjectHistorywithSimilarScaleandNature姓名Name学历、学位及专业特长ProfessionalPreparation详细任职历史（自现职开始）Appointments(inreversechronologicalorder)获得的国内或国际奖项Awards,Prizes,andHonorsReceived设计经验（主要填写相似工程）SynergisticActivities(alistoftotheeexamplesthatdemonstrateyourprofessionalcompetenceinsimilarproject)项目名称NameofProject1项目规模、特点及性质ProjectDescription项目名称NameofProject2项目规模、特点及性质ProjectDescription项目名称NameofProject3项目规模、特点及性质ProjectDescription拟在本项目中担任的职务及责任ProposedAppointmentinthisProjectD拟参与本项目的设计师/辅助人员ProposedStaff/SupportStaffDedicatedtothisProjectE签字盖章SignatureandStamp我谨代表前述申请参加本次国际征集的设计公司（设计联合体）声明：本表各页，加盖公章为记，所填一切内容属实，并同时在此授权本次竞赛组织者在其认为适当的时间和场合公开、使用有关信息。Icertify,asentrustedbythedesigncompany(jointdesignventure),underthelawsandregulationsofthePeople’sRepublicofChina,thatthisapplicationasstampedwiththeseal,andthedataandinformationsubmittedwithit,arealltrueandcorrect.Iauthorizethereleaseofanyinformationincaseoftheorganizer’sneed.填表人签名Preparer’sSignature:OfficialSealofCompanyOrJointVenture■公司法人代表LegalRepresentative:■日期Data(Year/Month/Day):■